Perth Children's Hospital (formerly Princess Margaret Hospital for Children), Perth, Western Australia, Australia; Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Western Australia, Australia. Electronic address: meredith.borland@health.wa.gov.au.

2

Starship Children's Health and the Liggins Institute, University of Auckland, Auckland, New Zealand.

3

Lady Cilento Children's Hospital, Brisbane, Queensland, Australia; Child Health Research Centre, School of Medicine, The University of Queensland, Queensland, Australia.

4

Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Bristol Royal Hospital for Children, Bristol, United Kingdom; Academic Department of Emergency Care, University of the West of England, Bristol, United Kingdom.

The Children's Hospital at Westmead, Sydney, New South Wales, Australia.

Abstract

STUDY OBJECTIVE:

Existing clinical decision rules guide management for head-injured children presenting 24 hours or sooner after injury, even though some may present greater than 24 hours afterward. We seek to determine the prevalence of traumatic brain injuries for patients presenting to emergency departments greater than 24 hours after injury and identify symptoms and signs to guide management.

METHODS:

This was a planned secondary analysis of the Australasian Paediatric Head Injury Rule Study, concentrating on first presentations greater than 24 hours after injury, with Glasgow Coma Scale scores 14 and 15. We sought associations with predictors of traumatic brain injury on computed tomography (CT) and clinically important traumatic brain injury.

CONCLUSION:

Delayed presentation after head injury, although infrequent, is significantly associated with traumatic brain injury. Evaluation of delayed presentations must consider identified factors associated with this increased risk.